“So… what kind of arthritis do I have?” The person who asked the question was a 60ish year old woman who had come to the office about two weeks ago for evaluation.

Diagnostic tests were ordered and now she was back to learn about her condition.

It turns out she joined the other 30 per cent or so of adults in the United States in her age group who have a condition called osteoarthritis (OA).

OA is the most common form of arthritis and affects more than 20 million adults. It’s been estimated that by the age of 70 almost all people have OA to some extent.

OA is a disease of articular cartilage, the gristle that caps the ends of long bones. Cartilage is a complex substance consisting of two basic materials: collagen and proteoglycans and one type of cell- the chondrocyte. Cartilage provides shock absorption as well gliding functions.

With OA, there is premature wear and tear that occurs as a result of a metabolic abnormality that causes the chondrocyte to produce destructive enzymes. There is a complex interplay of the cartilage, the synovium (lining of the joint), and the subchondral bone (the bone that lies underneath the cartilage. The result is premature wear and tear as well as local inflammation.

While OA is primarily a condition that affects weight-bearing joints such as the neck, low back, hips, and knees, it also affects other areas such as the hands and feet, particularly in women.

Risk factors for the development of OA include genetics, trauma (injury to the joint), and weight in the case of weight-bearing areas such as the low back and knees. There is less evidence that weight plays a role in inducing OA of the hips. However, once OA in the hips is present, weight plays a key role in making the symptoms worse.

Symptoms of OA include morning stiffness lasting less than one-half an hour, stiffness during the days with prolonged sitting, crepitus (crunching sounds that accompany joint movement), pain, and joint swelling. Joint fluid, called an “effusion” can develop.

As osteoarthritis progresses, it becomes harder for patients to limber up and to move without pain.

Diagnosis is usually suspected by history and physical examination. While confirmation can be obtained by x-rays, unfortunately, by the time x-ray changes occur in OA, it is late in the course of disease.

While magnetic resonance imaging is much more sensitive for making the diagnosis, because of expense, it is often not used.

Laboratory tests are usually negative or normal.

The treatment of OA is unsatisfactory, because, to date there is symptomatic treatment only. Therapy for the underlying cartilage loss as well as the metabolic abnormality that has caused the osteoarthritis is not available.

Symptomatic therapies consist of non-steroidal anti-inflammatory drugs (NSAIDS)- both oral as well as topical, analgesics (pain killers), injections of glucocorticoids (“cortisone”), and lubricants (the “rooster comb” injections), physical therapy, braces, splints, and so on.

Fortunately, recently, there is increasing evidence that regenerative therapies such as growth factors found in platelet-rich plasma (PRP) and autologous stem cells (a patient’s own stem cells) may help regrow cartilage that has been worn away.

While these findings are early, further research is anticipated.

In those who do not respond to conservative treatment, surgery may be required.

Options include cartilage sparing procedures where alignment of a joint is restored or cartilage sacrificing therapies where the joint is replaced.

Nathan Wei, MD FACP FACR is a board-certified rheumatologist and nationally known arthritis authority and expert. For more info: Arthritis Treatment and Arthritis Treatment Center

Nathan Wei, MD FACP FACR is a board-certified rheumatologist and nationally known arthritis authority and expert. For more info: http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html Arthritis Treatment and Arthritis Treatment Center

Author Bio: Nathan Wei, MD FACP FACR is a board-certified rheumatologist and nationally known arthritis authority and expert. For more info: Arthritis Treatment and Arthritis Treatment Center

Category: Advice
Keywords: osteoarthritis, osteoarthritis treatment, arthritis treatment, cartilage, stem cells, PRP